Document Detail

Clinical usefulness of and problems with three-dimensional CT angiography for the evaluation of arteriosclerotic stenosis of the carotid artery: comparison with conventional angiography, MRA, and ultrasound sonography.
MedLine Citation:
PMID:  10086495     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Prevention of stroke is aided by determination of the degree of carotid artery stenosis and progression of arterial sclerosis. Three-dimensional computed tomography (CT) angiography (3D-CTA) is a new method for evaluating the degree of arterial stenosis. The purpose of this study was to compare the accuracy of 3D-CTA with the "gold standard": conventional angiography, magnetic resonance angiography (MRA), and ultrasound sonography (US). METHODS: A total of 128 carotid bifurcations in 64 patients (42 men and 22 women; mean age, 68.5 years) were examined by 3D-CTA because of symptoms of cerebral infarction, carotid bruit, or findings suggestive of arteriosclerotic carotid artery stenosis on MRA screening. The following were used to compare 3D-CTA with conventional angiography, MRA and US: 1) estimation of the degree of stenosis; 2) depiction of irregularities in arterial walls, including calcification, intimal thickening, ulcers and plaque; and 3) surgical planning for carotid endarterectomy (CEA) and percutaneous transluminal angioplasty (PTA), and postoperative evaluation. RESULTS: A strong correlation was found between the degrees of stenosis estimated by conventional angiography and 3D-CTA MIP image (r = 0.987/p < 0.0001). On the other hand, stenosis was generally overestimated by MRA, which, however, has the advantage of being able to scan the carotid siphon to the middle cerebral artery at one time. Calcification and ulceration of the artery wall could be evaluated with 3D-CTA, whereas with US, progression of arterial sclerosis could be evaluated by differentiation of homogenous and heterogenous plaque. The anatomical relationships between the site of stenosis and the internal jugular vein and bony structures, which must be known before CEA, were confirmed by observation of rotated images using the shaded surface reconstruction (SSR) method. Because the hemodynamics of cross and collateral flows cannot be clearly imaged with 3D-CTA, standard angiography is needed to determine suitability for bypass surgery. CONCLUSIONS: The current method used in our hospital for the diagnosis of stenosis of the internal carotid artery includes MRA or US for initial screening, 3D-CTA for evaluation of the degree of stenosis and for preoperative and postoperative evaluation of CEA and PTA, and conventional angiography for evaluation of hemodynamics and determination of the indications for a bypass surgery.
T Sameshima; S Futami; Y Morita; K Yokogami; S Miyahara; Y Sameshima; T Goya; S Wakisaka
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  51     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-03-25     Completed Date:  1999-03-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  301-8; discussion 308-9     Citation Subset:  IM    
Department of Neurosurgery, Miyazaki Prefectural Nichinan Hospital, Japan.
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MeSH Terms
Calcinosis / diagnosis
Carotid Stenosis / diagnosis*,  pathology,  radiography,  ultrasonography
Cerebral Angiography*
Magnetic Resonance Imaging*
Middle Aged
Predictive Value of Tests
Severity of Illness Index
Tomography, X-Ray Computed*
Ulcer / diagnosis
Ultrasonography, Doppler, Color
Ultrasonography, Interventional*

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